CKD/renal failure

Stages 1-3: 20-30 min 6 monthly

Stages 4-5 post transplant 20-30 min 3 monthly

Stage 5, D, PD- 45-60min monthly

SGA at all stages

Dry weight, wet weight

Pre and post dialysis. If continuing to lose dry weight= losing fat and muscle. If coming off dialysis and still "wet" = losing fat and muscle NOT fluid.

BW should be adjusted if wt is <95% or >115% of IBW

K+ (3.5-5.5mmol/L)

Low= weakness, cellular impairement

High = irregular HB, nausea, weak pulse

PO4 (0.8-1.4mmol/L

High = itching, Ca+ and PO4 deposit in tissues

Stage 1- 87mmol/L/day

Stage 2- 87mmol/L/day

Stages 3-5 <100mmol/day avoid salt substitutes (high in K)

Stage 5 <100mmol/L/day " "

Transplant <100mmol/L/day. If stable, restrict Na to 80-100mmol/L/day

Fluid restriction? Dialysis? MUST meet restriction amount

Stage 1 & 2 = 2800-3800mg/day

Stage 3-5 Reduce to maintain normal serum level. Limit to 1mmol/kg IBW if serum is >6mmol/L

AJKD guideline: CKD 3-5D= 3 day food record preferred method to assess diet: on dialysis and NOT on dialysis

AJKD guidelines: CKD 3-5 or CKD5D(2D) 24hr recall, food frequency questionnaire = alternative methods

Stages 1-3= wt management and mx comorbidities

stages1-5 manage sodium

stage 3- moderate protein and malnutrition

stages 4-5 protein per DN prescritption- HIGHER if on dialysis!

foods high in PO4 = nuts, bacon, PB, cola and pepsi, beer, chocolate, muesli

PO4 from plant based = lower absorption (70%) from animal products = 100% absorption. FRESH is best, limit TA + animal proteins

Stage 1 >90

Stage 2 60-89

Stage 3a and 3b 30-59

4 15-29

5 <15

Stage 3 = prevent volume depletion, prevent bone-mineral disease, prevent electrolyte disturbances, prevent malnutrition

Stage 4-5= manage metabolic disturbances, prevent anaemia, malnutrition and acidosis, manage HTN, nausea and fluid balance

Previous and current: surgery, dialysis, stage of CKD

Anti-hypertensives (ACE inhibitors) eg PRIL
Diuretics (frusemide)
Renins (to lower K+)
Immunosuppressants (Cyclosporin, mycophenolate, Azathioprine)
Iron supps (EPO)
Steroids ("one")
Calcitriol (Vit D)

Remove excess fluid, swap cereal for toast (no milk), swap fresh fruit for dried fruit, break up water consumption throughout the day

Swap table salt for herbs and spices, swap convenience foods (T/A, servo food) for sandwiches, nut bars/un-slated trail mix, fruit, halve portions of meals eating out (eg pub)

Foods high in K+ = Sweetened beverages, muffins, hot chips, ice cream, sausage rolls.

If K+ is the problem, address discretionary. They're absorbed quicker, Therefore even if they're not as high as a fruit they're eating, whatever amount is in them will all be absorbed compared to a "healthier" food that's initially higher in K+.

Low K+ fruits = berries! passionfruit, apple, pear, melon, grapes, mandarin, watermelon

High K+ fruits = banana, dried fruit, pineapple, peach, mango, kiwi

Low K+ veg = cabbage, asparagus, tomato, carrots, capsicum, mushrooms, zucchini, onion, canned beetroot, cauliflower.

High K+ = avocado, corn, baked beans, veg juice, pumpkin

Limit to 1 starchy veg/day

Fruits and vegetables to decrease BW, BP and net acid production. Mediterranean diet in CKD 1- NOT on dialysis, with or without dyslipidemia; improve lipid profiles

CKD 3-5D (2D) at risk of protein-energy wasting, minimum 3 month trial of ONS to improve nutritional status

Protein- NOT on dialysis, WITH diabetes- 0.6-0.8g/Kgbw + glycemic control

CKD 3-5 metabolically stable NOT on dialysis and WITHOUT diabetes= low protein diet providing 0.55-0.6g/Kg bw/day OR a very low protein diet 0.28-0.43g/Kgbw + additional AA analogs to meet protein requirements of 0.55-0.6g/Kgbw.

Energy= for ideal BW (if diab neuropathy: <50% CHO)

K+ 2800-3800mg/day

Energy= minimum 146kJ/Kg IBW. 125-146kJ/kg IBW >60years of age

Protein 0.75-1.0g/Kg IBW

Energy <60yo = 146Kj/Kg IBW >60yo = 125-146Kj/KgIBW

K+ = <100mmol/Kg IBW

Fluid 500ml

energy= 146kJ/kg IBW + glucose from dialysis. Acute illness = >146kJ/Kg IBW

protein= 1.2g/Kg IBW. Acute illness >1.3g/Kg IBW

Fluid overloaded or HTN 800ml + PDUO

ONLY decrease K+ and PO4 if serum levels high

Protein requirements increase at commencement of dialysis

Peritoneal (optimal as less restrictive diet)

Haemodialysis (machine) 3x 4-5hours / week. If at home= 7-9h per night